Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Mar 2012
ReviewThe oviduct and ovarian cancer: causality, clinical implications, and "targeted prevention".
A novel origin for pelvic serous cancer (ovarian cancer) has been proposed in the distal oviduct. This has important implications, including both early detection in high-risk women and wisdom of relying on serological tests to detect a disease that begins so close to the peritoneal surfaces. With the recent discovery of premalignant disturbances in gene function in the tubal mucosa, the concept of targeted prevention is emerging whereby the interruption of a portion of the carcinogenic pathway will prevent cancer. This alternative to detect early malignancy is a new paradigm in the quest to prevent this deadly disease.
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Clin Obstet Gynecol · Mar 2012
ReviewIs sonographic assessment of the cervix necessary and helpful?
Transvaginal sonography of the cervix has emerged as a useful window into preterm parturition. Cervical sonography allows measurements of cervical length (CL), which can aid clinicians in identifying women at risk for preterm birth. The use of transvaginal assessments of CL can assist in the triage of patients with possible preterm labor. Recent studies also support the use of CL measurements as a means of determining appropriate candidates for cerclage placement and progesterone supplementation to reduce the risk of premature birth, further highlighting the importance of this modality in modern obstetric management.
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Clin Obstet Gynecol · Mar 2012
ReviewPlacenta, umbilical cord and amniotic fluid: the not-less-important accessories.
The placenta and umbilical cord are crucial to the survival and well-being of the fetus. In fact, disorders of either of these may lead to fetal death or severe morbidity. Yet, they are often not accorded appropriate attention in the prenatal sonographic examination. ⋯ Detection allows interventions that may improve perinatal and maternal outcomes. However, not infrequently, controversial findings, of uncertain significance, demonstrated on routine sonography lead to anxiety and worry. The goal of this chapter is to address the normal appearances of the placenta, cord, and fluid and to describe several of the more common conditions affecting these structures that the clinician may have to deal within pregnancy.
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Clin Obstet Gynecol · Mar 2012
ReviewPalliative and end-of-life care for patients with ovarian cancer.
Palliative care improves the quality of life of patients and their families through the prevention and treatment of distressing symptoms while addressing the psychological, social, and spiritual aspects of patient care. Emerging paradigms of delivery promote early involvement in the disease trajectory and specialty approaches to care. ⋯ Throughout the disease course, aggressive symptom management can improve patients' quality of life and their ability to tolerate and continue treatment. End-of-life care focuses on comfort, control, meaning, and support that become particularly intense when death is imminent.